EP2698178B1 - Pumpe mit Dosiersystem zur Abgabe von flüssiger Medikation - Google Patents

Pumpe mit Dosiersystem zur Abgabe von flüssiger Medikation Download PDF

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Publication number
EP2698178B1
EP2698178B1 EP13180530.1A EP13180530A EP2698178B1 EP 2698178 B1 EP2698178 B1 EP 2698178B1 EP 13180530 A EP13180530 A EP 13180530A EP 2698178 B1 EP2698178 B1 EP 2698178B1
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EP
European Patent Office
Prior art keywords
reservoir
valve
liquid medication
infusion pump
pump system
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Active
Application number
EP13180530.1A
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English (en)
French (fr)
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EP2698178A2 (de
EP2698178A3 (de
Inventor
Gary Searle
Roman Tunkel
William E. Tormey III
Andrew P. Leonczyk
David P. Pollock
Paul NAUMANN
Kenneth Focht
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Becton Dickinson and Co
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Becton Dickinson and Co
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Publication date
Application filed by Becton Dickinson and Co filed Critical Becton Dickinson and Co
Priority to EP20175159.1A priority Critical patent/EP3711794A1/de
Publication of EP2698178A2 publication Critical patent/EP2698178A2/de
Publication of EP2698178A3 publication Critical patent/EP2698178A3/de
Application granted granted Critical
Publication of EP2698178B1 publication Critical patent/EP2698178B1/de
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/142—Pressure infusion, e.g. using pumps
    • A61M5/14244—Pressure infusion, e.g. using pumps adapted to be carried by the patient, e.g. portable on the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/142—Pressure infusion, e.g. using pumps
    • A61M5/145—Pressure infusion, e.g. using pumps using pressurised reservoirs, e.g. pressurised by means of pistons
    • A61M5/1452—Pressure infusion, e.g. using pumps using pressurised reservoirs, e.g. pressurised by means of pistons pressurised by means of pistons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
    • A61M5/16804—Flow controllers
    • A61M5/16809—Flow controllers by repeated filling and emptying of an intermediate volume
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
    • A61M5/16877—Adjusting flow; Devices for setting a flow rate
    • A61M5/16881—Regulating valves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
    • A61M5/16831—Monitoring, detecting, signalling or eliminating infusion flow anomalies
    • A61M2005/16863—Occlusion detection
    • F—MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
    • F04—POSITIVE - DISPLACEMENT MACHINES FOR LIQUIDS; PUMPS FOR LIQUIDS OR ELASTIC FLUIDS
    • F04C—ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT MACHINES FOR LIQUIDS; ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT PUMPS
    • F04C2270/00—Control; Monitoring or safety arrangements
    • F04C2270/04—Force
    • F04C2270/041—Controlled or regulated

Definitions

  • the present invention relates generally to a fail-safe metering system for a pump engine or fluid driver that provides improved dosing accuracy for insulin and other liquid medications.
  • Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can lead to serious health complications and premature death, but there are well-known products available for people with diabetes to help control the disease and lower the risk of complications.
  • Treatment options for people with diabetes include specialized diets, oral medications and/or insulin therapy.
  • the primary goal for diabetes treatment is to control the patient's blood glucose (sugar) level in order to increase the chances of a complication-free life. It is not always easy, however, to achieve good diabetes management, while balancing other life demands and circumstances.
  • the first mode includes syringes and insulin pens that require a needle stick at each injection, typically three to four times per day. These devices are simple to use and relatively low in cost.
  • Another widely adopted and effective method of treatment for managing diabetes is the use of an insulin pump. Insulin pumps can help users keep their blood glucose levels within target ranges based on their individual needs, by providing continuous infusion of insulin at varying rates to more closely mimic the behavior of the pancreas. By using an insulin pump, users can match their insulin therapy to their lifestyles, rather than matching their lifestyles to how an insulin injection is working for them.
  • WO 2004/032994 A2 a system for the metering and delivery of small discrete volumes of liquid is known, wherein a fluid is moved from a reservoir through a displacement chamber by a plunger.
  • WO 2012/069308 A1 discloses an infusion pump with a dosing unit comprising a safety valve.
  • the valve for an infusion pump device comprises a pump connection intended to be fluidly connected to a piston pump, an infusion site connection intended to be fluidly connected to an infusion set and a reservoir connection intended to be fluidly connected to a liquid medicament reservoir.
  • the valve can be in a first state, where the pump connection is fluidly connected to the infusion site connection, and the reservoir connection is sealingly closed, and in a second state, where the pump connection is fluidly connected to the reservoir connection, and the infusion site connection is sealingly closed.
  • the valve comprises one or more conduits, grooves, and/or recesses connected to environment that are arranged in such a way that no path exists within the valve between the infusion site connection and the reservoir connection that does not cross at least one of said conduits, grooves, and/or recesses, thereby establishing a drain, independently if such a path is closed during a normal operation of the valve.
  • US 2009/149743 A1 describes a medical fluid injection system for injecting medical fluids such as radiographic fluids, wherein the system having a dual-syringe assembly.
  • One syringe is capable of holding a first fluid medium (such as contrast), and the second syringe is capable of holding a second medium (such as saline).
  • Each syringe comprises independent inlet and outlet parts.
  • WO 2012126744 A1 discloses an infusion system which is controlled by driving a displacing element in alternate fill and pump directions in a fluid chamber to define a varying displacement volume, and by synchronously operating a valve arrangement to alternately open and close first and second paths from the fluid chamber to a source and a connector, respectively, such that an infusion liquid is repeatedly sucked into the fluid chamber from the source and pumped from the fluid chamber through the connector,
  • the infusion system comprises a sensor for generating a measurement signal representative of fluid pressure in the displacement volume.
  • a controller is connected to intermittently effect a system test, in which the valve arrangement is operated to close the second fluid path, the displacing element is driven a given distance in the fill direction; and the measurement signal is obtained from the sensor during at least part of the system test.
  • the integrity of the infusion system is determined based on the measurement signal, e.g. by evaluating the temporal change in the measurement signal during and/or after the displacement.
  • the system test may identify a shortage of infusion liquid in the source or a leakage of air into the first fluid path.
  • Conventional insulin pumps are capable of delivering rapid or short-acting insulin 24 hours a day through a cannula (typically a hollow metal needle or a flexible plastic catheter) placed under the skin.
  • Insulin doses are typically administered at a basal rate and in a bolus dose. Basal insulin is delivered continuously over 24 hours, and strives to keep one's blood glucose levels in a consistent range between meals and overnight.
  • Some insulin pumps are capable of programming the basal rate of insulin to vary according to the different times of the day and night.
  • Bolus doses are typically administered when the user consumes a meal, and generally provide a single additional insulin injection to balance the carbohydrates consumed.
  • Some conventional insulin pumps enable the user to program the volume of the bolus dose in accordance with the size or type of the meal consumed.
  • Conventional insulin pumps also enable a user to infuse a correctional or supplemental bolus of insulin to compensate for a low blood glucose level at the time the user is calculating a meal bolus.
  • Insulin pumps deliver insulin over time rather than in single injections and thus typically result in less variation within the blood glucose range that is recommended by the American Diabetes Association.
  • Conventional insulin pumps may reduce the number of needle sticks which the patient must endure, and may make diabetes management easier and more effective for the user, to enhance the quality of the user's life.
  • MDIs direct injections
  • FBGM fasting blood glucose medication
  • patients may test for glucose in the blood prior to sleeping to determine whether a correction dose is required, e.g. after intake of a snack.
  • an infusion set typically consists of a pump connector, a length of tubing, and a hub or base from which a hollow metal infusion needle or flexible plastic catheter extends.
  • the base has an adhesive that retains the base on the skin surface during use. The base may be applied to the skin manually or with the aid of a manual or automatic insertion device. Often, the insertion device is a separate, stand-alone unit that the user is required to carry and provide.
  • a patch pump is an integrated device that combines most or all of the fluidic components (including the fluid reservoir and pumping mechanism) in a single housing which is adhesively attached to an infusion site, and does not require the use of a separate infusion (tubing) set.
  • a patch pump adheres to the skin, contains insulin (or other medication), and delivers the insulin over a period of time via an integrated subcutaneous cannula.
  • Some patch pumps communicate with a separate controller device wirelessly (as in one device sold by Insulet Corporation under the brand name OmniPod®), while others are completely self-contained. These devices usually need to be replaced on a frequent basis, such as every three days, when the reservoir is exhausted or complications may otherwise occur.
  • FIG. 1 An exemplary insulin patch pump 100 is shown in FIG. 1 .
  • the patch pump utilizes a single reservoir 110 that retains a full dose requirement for the duration of the pump device, which is typically 3 days.
  • a pump engine 120 or other fluid driver typically applies force directly to the single reservoir 110, either through a secondary element, such as a plunger, or by direct deformation of the reservoir 110. This causes insulin to flow out of the reservoir 110 via the fluid line 112 and the cannula 111 and into the subcutaneous (SC) tissue of the patient.
  • SC subcutaneous
  • a simple form of a fluid driver is a preloaded spring 220, as shown in FIG. 2 .
  • the continuous flow rate of insulin into the subcutaneous tissue is controlled only by a calibrated limiting orifice in the fluid line 212 or cannula 211, and the spring force applied to the reservoir 210 by the preloaded spring 220.
  • the flow rate of insulin into the subcutaneous tissue can be discontinuous by incorporating a directional control valve 330, such as an on/off valve, into the fluid line 312 to provide infusion via the cannula 311 when required, as shown in FIG. 3 .
  • a directional control valve 330 such as an on/off valve
  • the valve 330 when used with a fluid driver 320 could still fail in the open position, resulting in a single point failure which would allow the full dose of drug to be infused into the patient.
  • the valve 330 shown in FIG. 3 fails, the fluid path remains open and the pressurized reservoir 310 will be completely infused into the patient.
  • FIG. 4 illustrates another patch pump 400 for the treatment of diabetes.
  • the illustrated fluid driver is a pump engine or motor 420.
  • This device is typically a stepper motor or other device that behaves similarly, such as a mechanism that advances a small incremental dose from a syringe-style reservoir 410 to the infusion site via the fluid line 412 and the cannula 411, as shown in FIG. 4 .
  • the illustrated device provides a superior form of insulin therapy as compared with Multiple Daily Injections (MDIs), which is the prevalent method of insulin therapy for both type 1 and type 2 diabetes.
  • MDIs Multiple Daily Injections
  • the current trend for basal delivery in the industry is to pump smaller incremental doses over the target duration and thereby approach continuous infusion. Smaller incremental doses are also more suitable for pediatric applications.
  • Dosing accuracy is still a concern with the current trend of pump engines.
  • Applicable standards such as IEC 60601-2-24, require dose accuracy to be within +/- 5% of target, creating difficulty for conventional volumetric pumps, which push a plunger by extremely small linear translations, approximately 2 micrometers per step.
  • the same incremental movement of the plunger in a 3/10 cc syringe 510 having an inner diameter D1 of 0.338 inch, as illustrated in FIG. 5A provides one-eighth the dose for the same incremental movement as compared to a 3 ml syringe 520 or eight times the accuracy of a 3ml syringe 520 having an inner diameter D2 of 0.110 inch, as illustrated in FIG. 5B .
  • the higher accuracy of the 3/10 cc syringe 510 may eliminate or reduce dosing errors and enables the use of higher concentration drugs, such as U200 and U500 insulin, which is often prescribed for patients with type 2 diabetes.
  • An object of the present invention is to substantially address the above and other concerns, and provide higher levels of infusion accuracy in combination with a fail-safe metering system for an infusion pump that delivers insulin or other liquid medication.
  • Another object of the present invention is to address the inadvertent overdosing of a patient by only pre-loading and pressurizing a safe or less-than-harmful dose of medicament in the reservoir of the metering system in the insulin infusion pump.
  • Another object of the present invention is to provide a metering system that permits the use of higher concentration drugs while abiding by industry requirements for pump engine accuracy.
  • Another object of the present invention is to provide a metering system that permits fine incremental dosing to approximate continuous infusion.
  • Another object of the present invention is to provide a low-cost metering system that can be integrated as part of an infusion pump device with any type of fluid driver or pump engine, including pump engines with low or poor accuracy.
  • an alternative infusion pump system for dispensing liquid medication comprises a first reservoir for storing liquid medication; a second reservoir for storing liquid medication; a first valve configured in a first position to permit the flow of liquid medication from the first reservoir to the second reservoir, and in a second position to prevent the flow of liquid medication from the first reservoir to the second reservoir; and a second valve configured in a first position to permit the flow of liquid medication from the second reservoir to an infusion site, and in a second position to prevent the flow of liquid medication from the second reservoir to the infusion site; wherein the positions of the first and second valves are controlled by applying or not applying electrical potentials to said first and second valves.
  • this infusion pump system comprises a first fluid driver for expelling liquid medication from the first reservoir and a second fluid driver for expelling liquid medication from the second reservoir.
  • Embodiments of the present invention relate to a fail-safe metering system for a pump engine or fluid driver that provides improved insulin dosing accuracy for insulin and other liquid medications.
  • the infusion pump system generally includes a fluid driver in the form of a pump engine 620, a primary reservoir 610, and a metering system 630 including a secondary reservoir 640, at least one check valve 650, at least one directional control valve 660, and an adjustable flow valve 670.
  • the adjustable flow valve 670 is replaced by a calibrated limiting orifice.
  • the check valve(s) 650 is replaced by the directional control valve(s) 670.
  • Fluid lines 612, 613, 614 and 615 connect the various components of the system, as illustrated in FIG. 6 .
  • the pump engine 620 of the illustrative embodiments of the present invention is interchangeable.
  • the pump engine 620 may be a spring-driven pump, stepper motor driven pump, an electrochemical pump, an electro-osmotic pump, or any positive pressure pump.
  • the primary reservoir 610 or macro-reservoir is a bulk fluid storage chamber for storing and dispensing a medicament, such as insulin, and may comprise a 3 ml syringe.
  • the dosing accuracy of the primary reservoir's pump engine 620 could be anywhere within +/- 10% of target dose.
  • the secondary reservoir 640 or micro-reservoir is provided to limit inadvertent insulin delivery by only pre-loading and pressurizing a safe or less-than-harmful dose of insulin medicament within the secondary reservoir 640.
  • a fluid driver 641 which can be a preloaded spring, solenoid, or other type of fluid driver, delivers incremental micro-doses from the secondary reservoir to the infusion site.
  • the check valve 650 is provided to eliminate flow back to the primary reservoir during the secondary reservoir delivery cycle.
  • the pump engine 620 applies pressure to a plunger 619 to expel insulin from the primary reservoir 610 into the fluid line 615, opening the check valve 650, until the insulin has been transferred to the secondary reservoir 640.
  • the directional control valve 660 controls the isolation of the fluid path when filling or dispensing from the secondary reservoir 640.
  • the directional control valve 660 is electrically controlled and is normally closed to prevent unintentional delivery of insulin to the infusion site.
  • Embodiments of the directional control valve 660 include, but are not limited to, isolation valves such as gate valves, pinch valves, spool valves or the like.
  • the opening of the normally closed directional control valve 660 enables insulin to flow to the infusion site with the flow rate controlled by the adjustable flow valve 670.
  • a controller (not shown in Fig. 6 ) calculates the duration for which the directional control valve 660 remains open based on the pressure being applied to the insulin in the secondary reservoir 640 by the fluid driver 641 and the opening/orifice in the adjustable flow valve 670. That is, the controller converts the patient's dose requirements into flow rate and duration settings.
  • the pump engine 620 When the fluid level in the secondary reservoir 640 is low, the pump engine 620 is activated to transfer insulin from the primary reservoir 610 to the secondary reservoir 640. With the check valve 650 in an open position and the adjustable flow valve 670 in a closed position, insulin is permitted to flow through fluid lines 613, 614 and 615 into the secondary reservoir 640 from the primary reservoir 610.
  • Check valves such as the check valve 650, are typically spring loaded N/C (normally closed) valves in which a ball is engaged into a seat in a manner that blocks downstream flow through the orifice in the seat. Hence, when the line pressure opposing the ball increases beyond the rated cracking pressure of the check valve, the ball dislodges from the seat allowing downstream flow through the orifice in the seat.
  • check valve 650 occurs when the pump engine 620 moves the plunger 619, creating a positive pressure in the fluidic line 615 that is greater than the cracking pressure in the check valve 650, and the pressure in fluidic line 614/613, which is generated by the fluid driver 641.
  • the directional control valve 660 opens, while the check valve 650 is in a closed position, to allow flow to the infusion site via the fluid line 612 and a hollow metal needle or flexible plastic catheter 611 with the flow rate controlled by the adjustable flow valve 670.
  • the adjustable flow valve 670 include, but are not limited to, control valves that modulate flow by varying the diameter of the opening by a certain percentage, such as diaphragm valves or the like.
  • the line pressure which is the pressure applied to the secondary reservoir 640 by the fluid driver 641, such as a preloaded spring, is known and the flow of insulin is regulated depending on the dose requirement for basal or bolus.
  • the dose delivered is a function of the line pressure, the duration for which the directional control valve 660 is open, and the variable limiting orifice in the adjustable flow valve 670.
  • Ambient temperature and atmospheric pressure could also be factored into the infusion dose calculation to further improve dose accuracy.
  • the dosing accuracy of the metering system 630 with the secondary reservoir 640 of illustrative embodiments of the present invention provides higher levels of infusion accuracy that can be within +/- 1% of the target dose regardless of the pump engine chosen for the primary reservoir, while preventing the inadvertent overdosing of a patient by only pre-loading and pressurizing a safe or less-than-harmful dose of medicament in the secondary reservoir 640 of the metering system 630.
  • Illustrative embodiments of the metering system infusion pump device 600 of the present invention may include, but are not limited to, sensors for detecting occlusion or back pressure within the infusion pump device, sensors for detecting bubbles in the delivery line of the infusion pump device, sensors for detecting the fill status of the secondary reservoir 640 of the infusion pump device 600, including the end of the secondary reservoir 640 or insulin remaining in the secondary reservoir 640, sensors for detecting leakage in the infusion pump device 600, and sensors for measuring the flow rate of the insulin or other medications.
  • an infusion pump system 700 in accordance with another illustrative embodiment of the present invention combines the sensors and elements of the metering system 730 of the infusion pump, as in the embodiment of FIG. 6 , such as the check valve 750, the directional control valve 760 and the adjustable flow valve 770, into a Micro Electro Mechanical Systems (MEMS) chip 705 that is connected to the primary reservoir 710 and the secondary reservoir 740 via the fluid lines 713, 714 and 715.
  • MEMS Micro Electro Mechanical Systems
  • Combining these components into a MEMS chip 705 is a low-cost and efficient way to provide many of the metering system components and the sensing elements typically required in an insulin infusion pump in a smaller package, thus reducing the overall size of the infusion pump device.
  • the pump engine 720 when the fluid level in the secondary reservoir 740 is low, the pump engine 720 is activated to transfer insulin from the primary reservoir 710 to the secondary reservoir 740 by moving the plunger 719 within the reservoir 710. With the check valve 750 in an open position and the adjustable flow valve 770 in a closed position, insulin is forced to flow through fluid lines 713, 714 and 715 into the secondary reservoir 740 from the primary reservoir 710.
  • the directional control valve 760 opens, while the check valve 750 is in a closed position, to allow flow of the insulin from the pressurized secondary reservoir 740 to the infusion site via the fluid line 712 and into the hollow needle or catheter 711, with the flow rate being controlled by the adjustable flow valve 770.
  • the fluid driver 741 can deliver incremental micro-doses from the secondary reservoir 740 to the infusion site.
  • Infusion pump system 800 is another illustrative embodiment of the present invention incorporating metering system elements of an infusion pump device into a MEMS chip 805 and is shown in FIG. 8 .
  • the fluid delivery system 800 generally includes a pump engine 820 a primary reservoir 810, and a metering system 830 including a secondary reservoir 840, a fluid driver 841, a flow control valve 850, a directional control valve 860, an adjustable flow valve 870, a pressure sensor 880, and two position sensors 890, 891.
  • the pump engine 820 of illustrative embodiments of the present invention is interchangeable and may be a spring-driven pump, a stepper motor driven pump, an electrochemical pump, an electro-osmotic pump, or any positive pressure pump.
  • the primary reservoir 810 or macro-reservoir is a bulk fluid storage chamber for storing and dispensing insulin or other medicament, and may comprise a 3 ml syringe.
  • the dosing accuracy of pump engine 820 could vary within +/- 10% of the target dose.
  • the secondary reservoir 840 or micro-reservoir of the metering system 830 is provided to limit inadvertent insulin delivery by only pre-loading and pressurizing a safe or less-than-harmful dose of insulin medicament within the secondary reservoir 840.
  • a fluid driver 841 in the form of a preloaded spring, stepper motor, or other fluid driver delivers incremental micro-doses from the secondary reservoir 840.
  • One or more position sensors 890, 891 are connected to the secondary reservoir 840. The position sensors 890, 891 provide feedback to the pump controller on the fill status of the secondary reservoir 840.
  • the flow control valve 850 controls the insulin flow from the primary reservoir 810 to the secondary reservoir 840 via the fluid lines 813, 814 and 815.
  • the flow control valve 850 opens to fill the secondary reservoir 840 with insulin from the primary reservoir 810.
  • the flow control valve 850 allows partial delivery to the secondary reservoir 840, which allows increased dosing accuracy and the option of a larger secondary reservoir 840.
  • a simple pump engine such as a spring/elastic actuator or membrane, or any constant pressurized mechanism such as a gas actuator, may be utilized in the fluid delivery system 800. Refilling of the secondary reservoir 840 occurs between the incremental dose delivery to the patient, i.e., when insulin is not being delivered to the patient.
  • the directional control valve 860 controls the isolation of the fluid path, between the fluid lines 812 and 813, when dispensing from the secondary reservoir 840.
  • the directional control valve 860 is provided to prevent unintentional delivery of insulin to the infusion site by permitting the flow of insulin only when required to satisfy the patient's insulin requirement and only in the direction of the arrow on the valve 860, illustrated in FIG. 8 , from fluid line 813 into fluid line 812.
  • the opening of the directional control valve 860 enables insulin to flow to the infusion site with the flow rate controlled by the adjustable flow valve 870.
  • the pressure sensor 880 is used for sensing and monitoring the line pressure and can generate a signal to the pump controller confirming that the secondary reservoir 840 is filled in order to stop the pump engine 820 from pumping additional insulin to the secondary reservoir 840.
  • the single pressure sensor 880 is used to detect pressure decay, and by opening the valves 850, 860 and 870 sequentially, the single sensor 880 can determine where in the fluidic system a leak may exist, the fill state of both the primary reservoir 810 and the secondary reservoir 840, and whether partial or complete occlusion exists.
  • the position sensors 890, 891 can be used for this purpose, and the pressure sensor 880 can be utilized to determine leakage in the system.
  • the illustrative embodiment of the present invention in FIG. 8 combines the sensors and elements of the metering system, such as the flow control valve 850, the directional control valve 860, the adjustable flow valve 870 and the pressure sensor 880, into a Micro Electro Mechanical Systems (MEMS) chip 805 that is connected to the reservoirs 810 and 840.
  • MEMS Micro Electro Mechanical Systems
  • the pump engine 820 via the primary reservoir 810, is activated temporarily by a pump controller (not shown in FIG. 8 ) to fill the secondary reservoir 840 with insulin by opening the flow control valve 850 whenever the fluid level in the secondary reservoir 840 is low according to an electrical signal sent by the position sensors 890, 891 connected to the secondary reservoir 840.
  • a pump controller not shown in FIG. 8
  • the filled status of the secondary reservoir 840 is confirmed to the pump controller by the duration of the refill cycle, or by feedback from the pressure sensor 880, or with an electrical signal from the position sensors 890, 891 connected to the secondary reservoir 840.
  • the signal from the position sensor 891 is transmitted to the pump controller of the system 800 to close the flow control valve 850 and stop the pump engine 820 from pumping insulin from the primary reservoir 810.
  • the pressure sensor 880 can generate a similar signal to stop the pump engine 820 from pumping insulin from the primary reservoir 810, when the secondary reservoir 840 is filled either independently, when the pressure sensed has stabilized, or in conjunction with a second pressure sensor (not shown) located in the downstream fluidic line 813 or 814.
  • the secondary reservoir 840 can be of the same size as the smallest incremental dose requirement, e.g. 0.5 ⁇ L / 0.25 ⁇ L, such that one complete evacuation cycle of the secondary reservoir will deliver 0.5 ⁇ L / 0.25 ⁇ L to the patient. Due to the small diameter of the secondary reservoir 840, when the same linear translation of the syringe plunger provides a smaller dose, dosing accuracy is improved to within +/-1% of the target dose. Additionally, due to the relatively small geometry of the secondary reservoir 840, a maximum dose that can be delivered from a system failure is small, thus providing a fail-safe that prevents the patient from receiving an overdose of insulin. To deliver a large dose to a patient, such as bolus, multiple incrementing doses (equal or smaller than the volume of the secondary reservoir 840) are required.
  • Incremental dosing of insulin from the secondary reservoir 840 is facilitated by the opening of the directional control valve 860, which enables insulin flow from the pressurized secondary reservoir 840 to the infusion site, via the fluid line 812 and into the hollow needle or catheter 811.
  • the flow rate of the insulin is controlled by the adjustable flow valve 870.
  • the pump controller of the system 800 closes the directional control valve 860 and opens the flow control valve 850, thus repeating the cycle of filling the secondary reservoir 840 after each individual cycle.
  • the presence of the pressure sensor 880 at fluid line 815 allows the fluid delivery system 800 to determine how much medication was filled in the primary reservoir 810, since the sensed pressure is proportional to the displacement or position of the plunger 819 in the primary reservoir 810.
  • valve 850 is opened and the directional control valve 860 is closed.
  • the flow control valve 850 is closed and the directional control valve 860 is open.
  • the directional control valve 660, 760, 860 can be incrementally adjustable such that it can achieve the function of the adjustable flow valve 670, 770, 870. In such an embodiment, the adjustable flow valve 670, 770, 870 can be omitted.
  • Syringe-type reservoirs are shown in FIGS. 6-8 , but the reservoirs utilized in the instant invention can be rigid or flexible and the configuration can vary depending on the pump engine selected.
  • FIGS. 9 and 10 Additional illustrative embodiments of the present invention incorporating metering system elements of an infusion pump device into a MEMS chip are shown in FIGS. 9 and 10 .
  • FIG. 9 illustrates a metering system for an infusion pump device incorporated into a MEMS chip with an energized reservoir.
  • FIG. 10 illustrates a metering system for an infusion pump device incorporated into a MEMS chip with the micro-reservoir or secondary reservoir filled and emptied by a linear actuator.
  • the metering system 1000 generally includes a primary reservoir 7, a micro-reservoir 3 with engine or driver 4, pressure sensors 2a, 2b, a controller 8, first and second N/C (normally closed) flow control valves 1a and 1b, a controlled orifice 5, and fluidic interconnects or fluid lines 14-18.
  • FIG. 10 also shows a pump engine 9 or other fluid driver for the primary reservoir 7.
  • the pump engine 9 in illustrative embodiments of the present invention is optional and interchangeable, and may be a spring-driven pump, a stepper motor driven pump, an electrochemical pump, an electro-osmotic pump, or the like.
  • the primary reservoir 7 is a bulk fluid chamber for storing and dispensing insulin medicament, and may comprise a 3 ml syringe-style reservoir.
  • the secondary reservoir or micro-reservoir 3 of the metering system is provided to limit inadvertent insulin delivery by pre-loading and pressurizing only a safe or less-than-harmful dose of insulin medicament within the micro-reservoir 3.
  • a preloaded spring 4, or other fluid driver delivers incremental micro-doses from the micro-reservoir 3 to the infusion site.
  • One or more pressure sensors 2a, 2b are connected to the micro-reservoir 3.
  • the pressure sensors 2a, 2b provide feedback to the pump controller 8 on the fill status of the micro-reservoir 3, detect occlusion or back pressure in the infusion pump device, detect leakage in the infusion device, and detect the injection flow rate of the insulin in the infusion pump device by measuring the pressure in the fluid lines 17 and 18.
  • the pump controller 8 interfaces with the pressure sensors 2a, 2b and actuates various components of the metering system of the present invention, such as the flow control valves 1a and 1b, and can also interface with a host computer or wireless controller (not shown).
  • the first N/C flow control valve 1a controls the insulin flow from the primary reservoir 7 to the micro-reservoir 3.
  • the first N/C flow control valve 1a opens to fill the micro-reservoir 3 with insulin from the primary reservoir 7.
  • the second flow control valve 1b controls the isolation of the fluid path when dispensing from the micro-reservoir 3 to the infusion site and prevents unintentional delivery of insulin to the infusion site.
  • the controlled orifice 5 which may comprise an adjustable flow valve, is provided to allow the flow rate of insulin into the subcutaneous tissue of the patient to be calculated.
  • a check valve (not shown) can be optionally provided to eliminate flow back to the macro-reservoir or primary reservoir 7 during the micro-reservoir delivery cycle. Typically, such check valve would be incorporated into the system if the flow control valve N/C 1a were not part of the system.
  • FIGS. 9 and 10 both illustrate metering systems 1000, 1001 that can be incorporated into a MEMS chip in a manner similar to the embodiments illustrated in FIGS. 7 and 8 , wherein the combination of the flow control valve N/C 1a and the micro-reservoir 3 safeguard the infusion pump engine from inadvertent insulin delivery by pre-loading and pressurizing only a safe or less-than-harmful dose of insulin medicament within the micro-reservoir 3.
  • a fluid driver 4 in the form of a preloaded spring, a solenoid, or other fluid driver delivers incremental micro-doses from the micro-reservoir 3 to the infusion site in order to improve the accuracy of the insulin doses delivered to the infusion site to within +/-1% of the target dose.
  • the pressure sensors 2a, 2b illustrated in FIGS. 9 and 10 provide feedback on the fill status of the micro-reservoir 3, detect occlusion or back pressure in the infusion pump device, detect leakage in the infusion device, and detect the injection flow rate of the insulin in the infusion pump device.
  • FIG. 11 illustrates another embodiment of a metering system that can be incorporated into a MEMS chip of the present invention, wherein a MEMS actuator is utilized to shift the gate of a two position gate valve 11.
  • a MEMS actuator is utilized to shift the gate of a two position gate valve 11.
  • the central plate is actuated and slides with respect to the outer plates.
  • the gate valve 11 will allow flow from either the primary reservoir to the secondary reservoir or from the secondary reservoir to the infusion site.
  • the central plate of the gate valve 11 is aligned to allow flow from the primary reservoir to the secondary reservoir, as illustrated in FIG. 11 .
  • the gate valve 11, pressure sensors 2a, 2b, 2c, micro-reservoir 3 and engine 4 and accompanying interconnects can be incorporated into a custom manifold 50 or MEMS chip. Alternately, the gate valve 11 could include a third position, such that in the absence of electrical power, all flow is blocked.
  • a MEMS actuator is utilized to open two N/C displacement gate valves 12a and 12b, instead of the single gate valve 11, to allow flow independent control of the flow from the primary reservoir 7 to the secondary reservoir 3 and from the secondary reservoir 3 to the infusion site.
  • the central plate of the N/C gate valve 12a when an electric potential is applied to the plate of the N/C gate valve 12a, the central plate thereof is actuated and slides with respect to the outer plates. This causes the N/C gate valve 12a to align and open the flow channels from the primary reservoir 7 to the secondary reservoir 3. Removing the electrical power from N/C gate valve 12a shifts the central plate to the N/C position.
  • illustrative embodiments of the present invention provide higher levels of infusion accuracy in combination with a fail-safe metering system for an insulin infusion pump, prevent inadvertent overdosing of a patient by pre-loading and pressurizing only a safe or less-than-harmful dose of medicament in the reservoir of the metering system in the insulin infusion pump, permit the use of higher concentration drugs while abiding by industry requirements for pump engine accuracy, permit fine incremental dosing to approximate continuous infusion, and provide a low-cost metering system that is interchangeable with any type of pump engine, including pump engines with low accuracy.
  • the individual components used in the exemplary patch pump embodiments disclosed herein can be based on existing designs and technologies which are known in the art.
  • pump engines, fluidic assemblies and metering systems utilizing stepper motors, shape memory alloy (SMA) actuators, piezoelectric actuators, Micro Electro Mechanical Systems (MEMS) devices, and directional control valves may be used.
  • Fluid reservoirs may be rigid or deformable (e.g., with force applied by a movable plunger or preloaded spring).

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Claims (20)

  1. Infusionspumpensystem (600, 700, 800) zum Ausgeben eines flüssigen Medikaments, das aufweist:
    ein erstes Reservoir (7, 610, 710, 810) zum Speichern eines flüssigen Medikaments; und
    einen ersten Fluidtreiber (9, 620, 720, 820) zum Ausstoßen eines flüssigen Medikaments aus dem ersten Reservoir (7, 610, 710, 810),
    ein zweites Reservoir (3, 640, 740, 840) zum Speichern eines flüssigen Medikaments; und
    einen zweiten Fluidtreiber (4, 641, 741, 841) zum Ausstoßen eines flüssigen Medikaments aus dem zweiten Reservoir (3, 640, 740, 840),
    ein erstes Ventil (1a, 650, 750, 850), das derart ausgebildet ist, dass es das Strömen eines flüssigen Medikaments aus dem ersten Reservoir (7, 610, 710, 810) zu dem zweiten Reservoir (3, 640, 740, 840) steuert;
    ein zweites Ventil (1b, 660, 760, 860), das derart ausgebildet ist, dass es das Strömen eines flüssigen Medikaments aus dem zweiten Reservoir (3, 640, 740, 840) zu einer Infusionsstelle steuert; und
    wobei jedes des ersten (1a, 650, 750, 850) und des zweiten Ventils (1b, 660, 760, 860) selektiv geöffnet oder geschlossen wird, um ein flüssiges Medikament aus dem ersten Reservoir (7, 610, 710, 810) in das zweite Reservoir (3, 640, 740, 840) hineinzulassen und ein flüssiges Medikament aus dem zweiten Reservoir zu der Infusionsstelle auszugeben,
    dadurch gekennzeichnet, dass
    die maximale Speicherkapazität für ein flüssiges Medikament in dem zweiten Reservoir (3, 640, 740, 840) eine sichere oder weniger als eine für einen Benutzer gefährliche Dosis ist.
  2. Infusionspumpensystem (600, 700, 800) nach Anspruch1, bei dem das erste Ventil (1a, 650, 750, 850) ein Rückschlagventil ist und das zweite Ventil (1b, 660, 760, 860) ein Richtungssteuerventil ist.
  3. Infusionspumpensystem nach Anspruch 1, das ferner ein drittes Ventil (5, 670, 770, 870) zum Steuern der Strömungsrate eines flüssigen Medikaments zu der Infusionsstelle aufweist, wobei das dritte Ventil (5, 670, 770, 870) vorzugsweise ein einstellbares Strömungsventil ist, das eine einstellbare Öffnung aufweist, durch die ein flüssiges Medikament zu der Infusionsstelle strömt.
  4. Infusionspumpensystem (600, 700, 800) nach Anspruch 1, das ferner einen ersten Fluidtreiber (9, 620, 720, 820) zum Ausstoßen eines flüssigen Medikaments aus dem ersten Reservoir (7, 610, 710, 810) und einen zweiten Fluidtreiber (4, 641, 741, 841) zum Ausstoßen eines flüssigen Medikaments aus dem zweiten Reservoir (3, 640, 740, 840) aufweist, wobei das zweite Reservoir (3, 640, 740, 840), der zweite Fluidtreiber (4, 641, 741, 841), das erste Ventil (1a, 650, 750, 850), das zweite Ventil (1b, 660, 760, 860), das dritte Ventil (5, 670, 770, 870) und Fluidanschlüsse in einem Dosiersystem (630, 730, 830, 1000) enthalten sind.
  5. Infusionspumpensystem (600, 700, 800) nach Anspruch 3, das ferner eine Mikroelektromechanisches-System- (MEMS) Chipeinheit (705, 805) aufweist, die das erste Ventil (1a, 650, 750, 850), das zweite Ventil (1b, 660, 760, 860) und das dritte Ventil (5, 670, 770, 870) aufweist.
  6. Infusionspumpensystem (600, 700, 800) nach Anspruch 3, das ferner aufweist:
    einen ersten Sensor zum Sensieren und Überwachen eines Fluidleitungsdrucks zum Informieren einer Steuereinrichtung (8) darüber, wann das zweite Reservoir (3, 640, 740, 840) bis zu einem akzeptablen Pegel gefüllt ist, wobei die Steuereinrichtung (8) den ersten Fluidtreiber (9, 620, 720, 820) stoppt, wenn das zweite Reservoir (3, 640, 740, 840) den akzeptablen Pegel erreicht.
  7. Infusionspumpensystem (600, 700, 800) nach Anspruch 6, bei dem der erste Sensor ein Drucksensor ist und/oder bei dem der erste Sensor ausgebildet ist zum:
    Detektieren eines Druckabfalls;
    Bestimmen, wo ein Leck in dem fluidischen System vorhanden ist, durch einzelnes Öffnen eines oder mehrerer des ersten, des zweiten und des dritten Ventils;
    Bestimmen des Füllzustands des ersten (7, 610, 710, 810) oder des zweiten Reservoirs (3, 640, 740, 840); und/oder
    Bestimmen, ob eine teilweise oder vollständige Verstopfung in dem System vorhanden ist.
  8. Infusionspumpensystem (600, 700, 800) nach Anspruch 3, das ferner aufweist:
    einen zweiten Sensor zum Informieren einer Steuereinrichtung (8) darüber, wann die Menge an flüssigem Medikament in dem zweiten Reservoir (3, 640, 740, 840) auf einem niedrigen oder akzeptablen Pegel ist, wobei die Steuereinrichtung (8) den ersten Fluidtreiber (9, 620, 720, 820) zum Füllen des zweiten Reservoirs (3, 640, 740, 840) aktiviert, wenn die Menge an flüssigem Medikament in dem zweiten Reservoir (3, 640, 740, 840) auf dem niedrigen Pegel ist, und den ersten Fluidtreiber(9, 620, 720, 820) stoppt, wenn das zweite Reservoir (3, 640, 740, 840) den akzeptablen Pegel erreicht, wobei der zweite Sensor vorzugsweise ein Positionssensor ist, der derart ausgebildet ist, dass er die Position eines Kolbens in dem zweiten Reservoir (3, 640, 740, 840) detektiert.
  9. Infusionspumpensystem (600, 700, 800) Anspruch 3, bei dem eine inkrementelle Dosierung eines flüssigen Medikaments aus dem zweiten Reservoir (3, 640, 740, 840) zur Infusionsstelle erfolgt, wenn das erste Ventil (1a, 650, 750, 850) geschlossen ist, das zweite Ventil (1b, 660, 760, 860) offen ist und das dritten Ventil (5, 670, 770, 870) die Strömungsrate des flüssigen Medikaments zur Infusionsstelle steuert.
  10. Infusionspumpensystem (600, 700, 800) nach Anspruch 3, bei dem das erste Ventil (1a, 650, 750, 850) ein Strömungssteuerventil ist.
  11. Infusionspumpensystem (600, 700, 800) nach Anspruch 3, das ferner aufweist:
    einen oder mehrere Sensoren zum Detektieren von Verstopfung oder Gegendruck in dem Infusionspumpensystem (600, 700, 800);
    einen oder mehrere Sensoren zum Detektieren des Vorhandenseins von Blasen in einer Zuführleitung des Infusionspumpensystems (600, 700, 800);
    einen oder mehrere Sensoren zum Detektieren eines Füllzustands des zweiten Reservoirs (3, 640, 740, 840) des Infusionspumpensystems (600, 700, 800);
    einen oder mehrere Sensoren zum Detektieren einer Leckage in dem Infusionspumpensystem (600, 700, 800); und/oder
    einen oder mehrere Sensoren zum Messen einer Strömungsrate des flüssigen Medikaments in dem Infusionspumpensystem (600, 700, 800).
  12. Infusionspumpensystem (600, 700, 800) nach Anspruch 1, bei dem das erste Reservoir (7, 610, 710, 810) ein Spritzen-Reservoir ist und/oder bei dem mindesten ein Fluidtreiber einen Pumpenmotor aufweist.
  13. Infusionspumpensystem (600, 700, 800) nach Anspruch 1, bei dem die maximale Speicherkapazität eines flüssigen Medikaments in dem ersten Reservoir (7, 610, 710, 810) größer ist als diejenige des zweiten Reservoirs (3, 640, 740, 840).
  14. Infusionspumpensystem (600, 700, 800) nach Anspruch 3, bei dem das zweite Reservoir (3, 640, 740, 840), der zweite Fluidtreiber (4, 641, 741, 841), das erste Ventil (1a, 650, 750, 850), das zweite Ventil (1b, 660, 760, 860) und die dazugehörigen Fluidanschlüsse in einem Dosiersystem enthalten sind.
  15. Infusionspumpensystem (600, 700, 800) nach Anspruch 3, das ferner umfasst:
    einen zweiten Sensor zum Sensieren und Überwachen eines Fluidleitungsdrucks zwischen dem ersten Reservoir (7, 610, 710, 810) und dem zweiten Reservoir (3, 640, 740, 840) und Informieren einer Steuereinrichtung (8) darüber, wann das zweite Reservoir (3, 640, 740, 840) bis zu einem akzeptablen Pegel gefüllt ist, wobei die Steuereinrichtung (8) den Fluidtreiber daran hindert, einen Druck auf das erste Reservoir (7, 610, 710, 810) aufzubringen, wenn das zweite Reservoir (3, 640, 740, 840) den akzeptable Schwellwert erreicht.
  16. Infusionspumpensystem (600, 700, 800) nach Anspruch 3, bei dem das erste Ventil (1a, 650, 750, 850) und das zweite Ventil (1b, 660, 760, 860) jeweils ein Strömungssteuerventil aufweisen.
  17. Infusionspumpensystem (600, 700, 800) nach Anspruch 3, das ferner aufweist:
    eine Vielzahl von Drucksensoren, die mit dem zweiten Reservoir (3, 640, 740, 840) verbunden sind, um eine Rückmeldung über den Füllzustand des zweiten Reservoirs (3, 640, 740, 840) zu liefern, um eine Verstopfung in dem Infusionspumpensystem (600, 700, 800) zu detektieren, um einen Gegendruck in dem Infusionspumpensystem (600, 700, 800) zu detektieren und/oder um eine Strömungsrate eines flüssigen Medikaments in die Infusionsstelle zu detektieren.
  18. Infusionspumpensystem (600, 700, 800) zum Ausgeben eines flüssigen Medikaments, das aufweist:
    ein erstes Reservoir (7, 610, 710, 810) zum Speichern eines flüssigen Medikaments; und
    einen ersten Fluidtreiber (9, 620, 720, 820) zum Ausstoßen eines flüssigen Medikaments aus dem ersten Reservoir (7, 610, 710, 810),
    ein zweites Reservoir (3, 640, 740, 840) zum Speichern eines flüssigen Medikaments; und
    einen zweiten Fluidtreiber (4, 641, 741, 841) zum Ausstoßen eines flüssigen Medikaments aus dem zweiten Reservoir (3, 640, 740, 840),
    ein Ventil, das derart ausgebildet ist, dass es in einer ersten Position das Strömen eines flüssigen Medikaments aus dem ersten Reservoir (7, 610, 710, 810) zu dem zweiten Reservoir (3, 640, 740, 840) ermöglicht und in einer zweiten Position das Strömen eines flüssigen Medikaments aus dem zweiten Reservoir (3, 640, 740, 840) zu einer Infusionsstelle ermöglicht;
    wobei die erste und die zweite Position des Ventils durch Aufbringen oder Nichtaufbringen eines elektrischen Potentials auf das Ventil gesteuert werden,
    dadurch gekennzeichnet, dass
    die maximale Speicherkapazität für ein flüssiges Medikament in dem zweiten Reservoir (3, 640, 740, 840) eine sichere oder weniger als eine für einen Benutzer gefährliche Dosis ist.
  19. Infusionspumpensystem (600, 700, 800) nach Anspruch 18, das ferner einen ersten Fluidtreiber (9, 620, 720, 820) zum Ausstoßen eines flüssigen Medikaments aus dem ersten Reservoir (7, 610, 710, 810) und einen zweiten Fluidtreiber (4, 641, 741, 841) zum Ausstoßen eines flüssigen Medikaments aus dem zweiten Reservoir (3, 640, 740, 840) aufweist.
  20. Infusionspumpensystem (600, 700, 800) nach Anspruch 3, das ferner einen Mikroelektromechanisches-System- (MEMS) Chip (705, 805) aufweist, der die Ventile aufweist, wobei der MEMS-Chip (705, 805) vorzugsweise ferner das zweite Reservoir (3, 640, 740, 840) aufweist und/oder bei dem der MEMS-Chip (705, 805) vorzugsweise ferner den ersten Sensor aufweist.
EP13180530.1A 2012-08-15 2013-08-15 Pumpe mit Dosiersystem zur Abgabe von flüssiger Medikation Active EP2698178B1 (de)

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JP2014050686A (ja) 2014-03-20
US9867929B2 (en) 2018-01-16
JP7174089B2 (ja) 2022-11-17
CA2823345A1 (en) 2014-02-15
JP2019213910A (ja) 2019-12-19
CA2823345C (en) 2023-08-15
JP2021073037A (ja) 2021-05-13
ES2808399T3 (es) 2021-02-26
US20140052096A1 (en) 2014-02-20
EP2698178A2 (de) 2014-02-19
JP6616933B2 (ja) 2019-12-04
EP3711794A1 (de) 2020-09-23
JP6839240B2 (ja) 2021-03-03
EP2698178A3 (de) 2014-06-25
CN203647799U (zh) 2014-06-18

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